前庭诱发肌源性电位预测突聋患者疗效的临床价值

doi:10.6040/j.issn.1673-3770.1.2020.063

摘要/Abstract

摘要： 目的分析单侧突发性耳聋患者的疗效,探讨前庭功能与预后的关系。方法回顾性分析59例(59耳)突发性耳聋患者的临床资料,观察临床疗效,根据前庭功能结果探讨对预后的影响。结果 59例突发性耳聋患者在治疗前共进行了183项前庭功能检查,眼性前庭诱发肌源性电位(oVEMP)和颈性前庭诱发肌源性电位(cVEMP)异常的突聋患者显示出更低的治疗总有效率;oVEMP和cVEMP正常的突聋患者受损频率听力提高更明显。冷热试验(Caloric Test)和视频头脉冲试验(vHIT)的正常与否对突聋患者的总有效率和受损听力的提高无影响。cVEMP和oVEMP都异常的患者治疗无效率比仅其中一项异常的患者高,受损听力恢复程度也比仅其中一项异常的患者差。结论 oVEMP和cVEMP异常的突聋患者疗效较差,oVEMP和cVEMP正常的突聋患者有更好的听力恢复。oVEMP和cVEMP功能可能是预测突发性聋患者预后的有效指标。前庭功能异常提示突发性聋患者的内耳病变范围较大、程度较重。

关键词: 突发性耳聋, 前庭功能, 前庭诱发肌源性电位, 冷热试验, 视频头脉冲试验

Abstract: Objective To analyze the clinical outcomes of patients with unilateral idiopathic sudden sensorineural hearing loss(SSNHL)and explore the relationship between vestibular function and prognosis in patients with SSNHL. Methods A retrospective analysis of 59 patients(59 ears)with SSNHL was performed. A total of 183 vestibular function tests were performed in all patients to assess the influence of vestibular functions on the clinical outcome of SSNHL. Results Treatments were less effective in patients with abnormalities in ocular vestibular evoked myogenic potential(oVEMP)or cervical vestibular evoked myogenic potential(cVEMP). Those with normal oVEMP and cVEMP had relatively better hearing recovery. The outcomes of the caloric test or video head impulse test showed no association with the efficacy of treatment or hearing recovery in patients with SSNHL. Treatment was less effective in patients with abnormalities in both oVEMP and cVEMP, who also had worse hearing recovery than those who had an abnormal finding in only one of the two tests. Conclusions Patients with abnormal oVEMP or cVEMP results had poor clinical outcomes, while those with normal oVEMP and cVEMP demonstrated better hearing recovery with treatment. Thus, oVEMP and cVEMP could be effective indices to predict the prognosis of patients with SSNHL. An abnormal vestibular function is a definite indicator of a wider and more severe pathological change in the inner ear of patients with SSNHL.

Key words: Idiopathic sudden sensorineural hearing loss, Vestibular function, Vestibular evoked myogenic potential, Caloric test, Video head impulse test

中图分类号:

R764.43

梁敏,吴悔,陈建勇,张勤,李姝娜,郑贵亮,何景春,陈向平,杨军. 前庭诱发肌源性电位预测突聋患者疗效的临床价值[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 27-32.

参考文献

[1] Fujimoto C, Egami N, Kinoshita M, et al. Involvement of vestibular organs in idiopathic sudden hearing loss with vertigo: an analysis using oVEMP and cVEMP testing[J]. Clin Neurophysiol, 2015, 126(5): 1033-1038. doi:10.1016/j.clinph.2014.07.028.
[2] Nakashima T, Yanagita N. Outcome of sudden deafness with and without Vertigo[J]. Laryngoscope, 1993, 103(10): 1145-1149. doi:10.1288/00005537-199310000-00012.
[3] Shaia FT, Sheehy JL. Sudden sensori-neural hearing impairment: a report of 1, 220 cases[J]. Laryngoscope, 1976, 86(3): 389-398. doi:10.1288/00005537-197603000-00008.
[4] Mattox DE, Simmons FB. Natural history of sudden sensorineural hearing loss[J]. Ann Otol Rhinol Laryngol, 1977, 86(4): 463-480. doi:10.1177/0003489477-08600406.
[5] Wilson WR, Laird N, Kavesh DA. Electronystagmographic findings in idiopathic sudden hearing loss[J]. Am J Otolaryngol, 1982, 3(4): 279-285. doi:10.1016/s0196-0709(82)80067-7.
[6] Oiticica J, Bittar RS, Castro CC, et al. Contribution of audiovestibular tests to the topographic diagnosis of sudden deafness[J]. Int Arch Otorhinolaryngol, 2013, 17(3): 305-314. doi:10.7162/s1809-977720130003000011.
[7] 中华耳鼻咽喉头颈外科杂志编辑委员会, 中华医学会耳鼻咽喉头颈外科学分会. 突发性聋诊断和治疗指南(2015)[J]. 中华耳鼻咽喉头颈外科杂志, 2015, 50(6): 443-447. doi:10.1016/j.clinph.2014.07.028.
[8] Sokolov M, Gordon KA, Polonenko M, et al. Vestibular and balance function is often impaired in children with profound unilateral sensorineural hearing loss[J]. Hear Res, 2019, 372: 52-61. doi:10.1016/j.heares.2018.03.032.
[9] Arbusow V, Schulz P, Strupp M, et al. Distribution of Herpes simplex virus type 1 in human geniculate and vestibular ganglia: implications for vestibular neuritis[J]. Ann Neurol, 1999, 46(3): 416-419. doi:10.1002/1531-8249(199909)46:3416::aid-ana20>3.0.co;2-w.
[10] Korres S, Stamatiou GA, Gkoritsa E, et al. Prognosis of patients with idiopathic sudden hearing loss: role of vestibular assessment[J]. J Laryngol Otol, 2011, 125(3): 251-257. doi:10.1017/s0022215110002082.
[11] You TZ, Wang SJ, Young YH. Registering grades of sudden deafness to predict the hearing outcome via an inner-ear test battery[J]. Int J Audiol, 2014, 53(3): 153-158. doi:10.3109/14992027.2013.851798.
[12] Wang CT, Huang TW, Kuo SW, et al. Correlation between audiovestibular function tests and hearing outcomes in severe to profound sudden sensorineural hearing loss[J]. Ear Hear, 2009, 30(1): 110-114. doi:10.1097/aud.0b013e318192655e.
[13] Park HM, Jung SW, Rhee CK. Vestibular diagnosis as prognostic indicator in sudden hearing loss with Vertigo[J]. Acta Otolaryngol Suppl, 2001, 545: 80-83.
[14] Hong SM, Byun JY, Park CH, et al. Saccular damage in patients with idiopathic sudden sensorineural hearing loss without Vertigo[J]. Otolaryngol Head Neck Surg, 2008, 139(4): 541-545. doi:10.1016/j.otohns.2008.07.003.
[15] Iwasaki S, Takai Y, Ozeki H, et al. Extent of lesions in idiopathic sudden hearing loss with vertigo: study using click and galvanic vestibular evoked myogenic potentials[J]. Arch Otolaryngol Head Neck Surg, 2005, 131(10): 857-862. doi:10.1001/archotol.131.10.857.
[16] Gussen R. Sudden deafnfess of vascular origin: a human temporal bone study[J]. Ann Otol Rhinol Laryngol, 1976, 85(1 pt 1): 94-100. doi:10.1177/000348947-608500117.
[17] Inagaki T, Cureoglu S, Morita N, et al. Vestibular system changes in sudden deafness with and without vertigo: a human temporal bone study[J]. Otol Neurotol, 2012, 33(7): 1151-1155. doi:10.1097/mao.0b013e3182-635440.
[18] Ishii T, Toriyama M. Sudden deafness with severe loss of cochlear neurons[J]. Ann Otol Rhinol Laryngol, 1977, 86(4 pt 1): 541-547. doi:10.1177/00034894770-8600414.
[19] Schuknecht HF, Donovan ED. The pathology of idiopathic sudden sensorineural hearing loss[J]. Arch Otorhinolaryngol, 1986, 243(1): 1-15. doi:10.1007/bf00457899.
[20] Yood TH, Paparella MM, Schacern PA, et al. Histopathology of sudden hearing loss[J]. Laryngoscope, 1990, 100(7): 707-715. doi:10.1288/00005537-199007000-00006.
[21] 李静, 刘兴健, 刘宸箐, 等. 突发性聋与前庭神经炎的前庭损伤差异性研究[J]. 中国耳鼻咽喉头颈外科, 2017, 24(1): 25-27. doi:10.16066/j.1672-7002.2017.01.005. LI Jing, LIU Xingjian, LIU Chenqing, et al. Study on difference of vestibular damage of sudden deafness and vestibular neuritis[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2017, 24(1): 25-27. doi:10.16066/j.1672-7002.2017.01.005.
[22] Bartolomeo M, Biboulet R, Pierre G, et al. Value of the video head impulse test in assessing vestibular deficits following vestibular neuritis[J]. Eur Arch Oto-Rhino-Laryngol, 2014, 271(4): 681-688. doi:10.1007/s00405-013-2451-y.
[23] 高林溪, 林颖, 邱建华. 视频头脉冲试验临床研究进展[J]. 听力学及言语疾病杂志, 2015, 23(5): 554-558. doi:10.3969/j.issn.1006-7299.2015.05.028.
[24] Hou L, Chen T, Xu K, et al. Evaluation of the injured range of vestibular superior and inferior nerves in sudden deafness patients with Vertigo using video head impulse test[J]. Chin J Otorhinolaryngol Head Neck Surg, 2015, 50(9): 718-723.

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